Re: What is "Medical Care"?

Topics: Health
09 Oct 1993

From: ervan

I do return to the main point after the break line below.

> Ervan says:
> > Either health care
> > becomes elastic via personal choice or via government rationing. Utopia
> > is not an option.
> [ We can afford all of the medical care we "need" but not everything
> that is for sale. ]

"To each according to his need". I thought this was a dead idea
outside of the beltway? Regardless, we lived essentially without
health care 100 years ago. So, our 'need' is zero. We probably can
afford that. There is no 'need' for health care, it's merely a
question of how much we want to buy.

The CHP does define need and it forces us to pay for it. As a consultant,
I would be forced to buy insurance from the Texas government 'cooperative'
(I doubt it) that includes drug rehabilitation, psychiatric counseling,
and possibly abortion. I have no intention of using any of those
services. They are clearly not part of my need.

> [ Medical inflation is largely because of the marketing success of the
> the health care industry with new products. ]

So are you proposing that the government should not let me buy what I want
but instead only let me have what it thinks is good for me (or in this
case what is cost effective from its point of view)? If advertisement
is so evil, are we to prefer letting bureaucrats be advertised to and
then deciding for us versus letting ourselves be propogandized?

> [ What if software companies did this? ]

They do it now. What's the problem? Software quality continues
to improve. Paradox just lowered its price from $500 to $120. Oh
curse those dreadful companies that advertise their products!

> [ such advertising causes more and more things, e.g. dieticians, to
> be classed as health care and they must be paid for. ]

An artifact of it being illegal to advertise prices for health care.
Another ridiculous law that we should get rid of. The government is using
its own failure to justify more intervention on the premise that the
market is not working. I cannot believe that people say that with
a straight face.

The debate returns to the main point here:

> [ socialized medicine curbs technology costs by rewarding slightly inferior
> but dramatically cheaper treatments. ]

Which only begs the question. You are contrasting socialized rationing
with buy-everything-we-can-use. Yes, of course, rationing restricts
cost. But, the free market restricts cost too. Why would the government
do a better job at making trade-offs than individuals would? All of the
evidence is that it does a worse job.

> [ The Western world mostly has socialized medicine that is cheaper
> but not as effective. Do we want to make that trade-off? ]

I have not found much in detail about Western Europe. What I know about
Canada is that it has failed at cost containment but has succeeded at
health care containment. When Canada socialized health care 15(?) years
ago, it was spending 75% as much per capita as the U.S. That was due
to dietary and lifestyle factors as well as simply not buying as much.
Today, with multiple month waiting lists for surgery, Canada spends
75% as much per capita as the U.S.

But of course that's not really the point. If I want to spend 20%
of my income on health care instead of 10%, why does it make sense
for the government to tell me I cannot? We could have tremendous
cost containment by banning medical care!

That socialized medicine does as well as it does at providing technologically
almost up to date services is due to its adopting innovation generated in the
quasi-free market U.S.

> [ how much we are willing to spend should be debated ]

Okay, so the question is once we have decided how much to spend would it
be better to spend it via government rationing or give it to people in
the form of vouchers?